title: Use of imaging and biomarker tests for posttreatment care of early-stage breast cancer survivors.
abstract: BACKGROUND
  The American Society of Clinical Oncology (ASCO) recently released a "Top Five" list of opportunities to improve the quality of cancer care. Item 4 on the list advises against using advanced imaging and biomarkers for surveillance in patients with breast cancer who are treated with curative intent. This study examined concordance with ASCO follow-up care guidelines for breast cancer survivors treated at an academic medical center.
  
  
  METHODS
  Claims data and medical records were reviewed and abstracted for early stage breast cancer survivors starting 1 year post diagnosis. A trained abstractor classified imaging tests as diagnostic or surveillance. Proportions and frequencies were generated for receipt of services. Multilevel logistic regression was used to estimate factors associated with receiving recommended and nonrecommended services and biomarker tests.
  
  
  RESULTS
  Records were available for 258 patients. Mean age at diagnosis was 58 years (standard deviation of 13 years), mean time since diagnosis was 6 years (standard deviation of 2 years), and 71% were stage 0/1. Only 47% of the sample received a mammogram within 1 year of diagnosis, and 55% of the sample received at least 1 nonrecommended imaging service for surveillance purposes. Seventy-seven percent of the sample received at least 1 nonrecommended biomarker test. Regression results indicate that main treating physician, advanced disease stage, younger age at diagnosis, and greater number of years since diagnosis were associated with receiving nonrecommended services for surveillance.
  
  
  CONCLUSIONS
  Use of nonrecommended services for surveillance occurs frequently among early-stage breast cancer survivors. There are opportunities to increase use of guideline concordant posttreatment care for breast cancer survivors.
authors.affiliation: University of California Los Angeles (UCLA) Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, California; Division of Cancer Prevention and Control Research Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Hahn
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism*; D003266:Continuity of Patient Care / Q000592:standards*; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D011159:Population Surveillance
chemical_list: D014408:Biomarkers, Tumor
keywords: breast cancer; guideline adherence; health services; posttreatment care; surveillance